MEDICARE: MR. GERALD VINCENT QUINNAN III LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	128114	NY

General Provider Information

NPI Number	:	1467322511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD VINCENT QUINNAN III LMSW

Provider Business Mailing Address
First Line	:	30 LAKE AVE APT 319
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2598
Country	:	US
Telephone Number	:	301-801-3448
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PROSPECT ST STE 2
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1367
Country	:	US
Telephone Number	:	518-810-6466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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